Skip to main content
SpringerLink
Log in

Nonoperative Management of Appendiceal Phlegmon or Abscess with an Appendicolith in Children

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

The optimal treatment of appendiceal phlegmon or abscess with an appendicolith is controversial. This study aimed to evaluate outcomes and prognosis of nonoperative management of appendiceal phlegmon or abscess with an appendicolith in children.

Methods

From 2007 to 2011, 105 children with appendiceal phlegmon or abscess who were treated nonoperatively without interval appendectomy were reviewed. Average follow-up of subjects was 2.4 years. Data were compared between subjects with and without an appendicolith or persistent presence and disappearance of an appendicolith.

Results

The success rate for nonoperative therapy for appendiceal phlegmon or abscess with appendicolith was 95.9 %. The risk of recurrent appendicitis in appendiceal phlegmon or abscess with appendicolith (19.1 %) was higher than that without appendicolith (8.9 %, P = 0.132). The rate of appendicolith disappearance during follow-up was 80.9 %. The persistent presence of an appendicolith was associated with a significantly higher recurrence rate (66.7 %) compared with appendicolith disappearance (7.9 %, P < 0.05).

Conclusion

Appendiceal phlegmon or abscess with an appendicolith can be managed nonoperatively, and most appendicoliths can be resolved. Persistent presence of an appendicolith is a significant risk factor for recurrent appendicitis. Interval appendectomy is recommended for persistent presence of appendicolith, but is not indicated in cases without appendicolith or appendicolith disappearance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Nance ML, Adamson WT, Hedrick HL. Appendicitis in the young child: a continuing diagnostic challenge. Pediatr Emerg Care 2000;16:160–162.

    Article  PubMed  CAS  Google Scholar 

  2. Pearl RH, Hale DA, Molloy M, Schutt DC, Jaques DP. Pediatric appendectomy. J Pediatr Surg 1995;30:173–178.

    Article  PubMed  CAS  Google Scholar 

  3. Alaedeen DI, Cook M, Chwals WJ. Appendiceal fecalith is associated with early perforation in pediatric patients. J Pediatr Surg 2008;43:889–892.

    Article  PubMed  Google Scholar 

  4. Aprahamian CJ, Barnhart DC, Bledsoe SE, Vaid Y, Harmon CM. Failure in the nonoperative management of pediatric ruptured appendicitis: predictors and consequences. J Pediatr Surg 2007;42:934–938.

    Article  PubMed  Google Scholar 

  5. Levin T, Whyte C, Borzykowski R, Han B, Blitman N, Harris B. Nonoperative management of perforated appendicitis in children: can CT predict outcome? Pediatr Radiol 2007;37:251–255.

    Article  PubMed  Google Scholar 

  6. Tsai HM, Shan YS, Lin PW, Lin XZ, Chen CY. Clinical analysis of the predictive factors for recurrent appendicitis after initial nonoperative treatment of perforated appendicitis. Am J Surg 2006;192:311–316.

    Article  PubMed  Google Scholar 

  7. Ein SH, Langer JC, Daneman A. Nonoperative management of pediatric ruptured appendix with inflammatory mass or abscess: presence of an appendicolith predicts recurrent appendicitis. J Pediatr Surg 2005;40:1612–1615.

    Article  PubMed  Google Scholar 

  8. Friedland JA, Siegel MJ. CT appearance of acute appendicitis in childhood. AJR Am J Roentgenol 1997;168:439–442.

    Article  PubMed  CAS  Google Scholar 

  9. Lowe LH, Penney MW, Scheker LE, Perez R Jr, Stein SM, Heller RM, Shyr Y, Hernanz-Schulman M. Appendicolith revealed on CT in children with suspected appendicitis: how specific is it in the diagnosis of appendicitis? AJR Am J Roentgenol 2000;175:981–984.

    Article  PubMed  CAS  Google Scholar 

  10. Rabinowitz CB, Egglin TK, Beland MD, Mayo-Smith WW. Outcomes in 74 patients with an appendicolith who did not undergo surgery: is follow-up imaging necessary? Emerg Radiol 2007;14:161–165.

    Article  PubMed  Google Scholar 

  11. Williams RF, Blakely ML, Fischer PE, Streck CJ, Dassinger MS, Gupta H, Renaud EJ, Eubanks JW, Huang EY, Hixson SD, Langham MR. Diagnosing ruptured appendicitis preoperatively in pediatric patients. J Am Coll Surg 2009;208:819–825.

    Article  PubMed  Google Scholar 

  12. Roach JP, Partrick DA, Bruny JL, Allshouse MJ, Karrer FM, Ziegler MM. Complicated appendicitis in children: a clear role for drainage and delayed appendectomy. Am J Surg 2007;194:769–772.

    Article  PubMed  Google Scholar 

  13. Gillick J, Velayudham M, Puri P. Conservative management of appendix mass in children. Br J Surg 2001;88:1539–1542.

    Article  PubMed  CAS  Google Scholar 

  14. Erdoğan D, Karaman I, Narci A, Karaman A, Cavuşoğlu YH, Aslan MK, Cakmak O. Comparison of two methods for the management of appendicular mass in children. Pediatr Surg Int 2005;21:81–83.

    Article  PubMed  Google Scholar 

  15. Hall NJ, Jones CE, Eaton S, Stanton MP, Burge DM. Is interval appendicectomy justified after successful nonoperative treatment of an appendix mass in children? A systematic review. J Pediatr Surg 2011;46:767–771.

    Article  PubMed  Google Scholar 

  16. Meshikhes AW. Management of appendiceal mass: controversial issues revisited. J Gastrointest Surg 2008;12:767–775.

    Article  PubMed  Google Scholar 

  17. Andersson RE, Petzold MG. Nonsurgical treatment of appendiceal abscess or phlegmon: a systematic review and meta-analysis. Ann Surg 2007;246:741–748.

    Article  PubMed  Google Scholar 

  18. Willemsen PJ, Hoorntje LE, Eddes EH, Ploeg RJ. The need for interval appendectomy after resolution of an appendiceal mass questioned. Dig Surg 2002;19:216–220.

    Article  PubMed  Google Scholar 

  19. Dixon MR, Haukoos JS, Park IU, Oliak D, Kumar RR, Arnell TD, Stamos MJ. An assessment of the severity of recurrent appendicitis. Am J Surg 2003;186:718–722.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatric Surgery, Shengjing Hospital of China Medical University, No. 36 Sanhao St, Heping District, Shenyang, China, 110004

    Hai-Lan Zhang, Yu-Zuo Bai, Xin Zhou & Wei-Lin Wang

Authors
  1. Hai-Lan Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yu-Zuo Bai
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xin Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wei-Lin Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wei-Lin Wang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zhang, HL., Bai, YZ., Zhou, X. et al. Nonoperative Management of Appendiceal Phlegmon or Abscess with an Appendicolith in Children. J Gastrointest Surg 17, 766–770 (2013). https://doi.org/10.1007/s11605-013-2143-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-013-2143-3

Keywords

Search

Navigation